Nephritis

Last updated
Nephritis
Hunter enlarged kidney.jpg
Enlarged kidney (anatomy)
Specialty Nephrology
TypesGlomerulonephritis [1] and Interstitial nephritis [2]
Diagnostic method Ultrasound, X-ray [3]
TreatmentDepends on type(See type)

Nephritis is inflammation of the kidneys and may involve the glomeruli, tubules, or interstitial tissue surrounding the glomeruli and tubules. [4] It is one of several different types of nephropathy.

Contents

Types

Causes

Nephritis is often caused by infections, and toxins, but is most commonly caused by autoimmune disorders that affect the major organs like kidneys. [5]

Mechanism

Renin-angiotensin system Renin-angiotensin system in man shadow.svg
Renin–angiotensin system

Nephritis can produce glomerular injury, by disturbing the glomerular structure with inflammatory cell proliferation. [10] This can lead to reduced glomerular blood flow, leading to reduced urine output (oliguria) [11] and retention of waste products (uremia). [12] As a result, red blood cells may leak out of damaged glomeruli, causing blood to appear in the urine (hematuria). [13]

Low renal blood flow activates the renin–angiotensin–aldosterone system (RAAS), causing fluid retention and mild hypertension. [14] As the kidneys inflame, they begin to excrete needed protein from the affected individual's body into the urine stream. This condition is called proteinuria. [15]

Loss of necessary protein due to nephritis can result in several life-threatening symptoms. The most serious complication of nephritis can occur if there is significant loss of the proteins that keep blood from clotting excessively. Loss of these proteins can result in blood clots, causing sudden stroke. [16]

Diagnosis

The diagnosis depends on the cause of the nephritis, and in the case of lupus nephritis, blood tests, X-rays and an ultrasound can help ascertain if the individual has the condition. [3]

Treatment

Disease burden of nephritis/nephrosis worldwide in 2004.
.mw-parser-output .refbegin{font-size:90%;margin-bottom:0.5em}.mw-parser-output .refbegin-hanging-indents>ul{margin-left:0}.mw-parser-output .refbegin-hanging-indents>ul>li{margin-left:0;padding-left:3.2em;text-indent:-3.2em}.mw-parser-output .refbegin-hanging-indents ul,.mw-parser-output .refbegin-hanging-indents ul li{list-style:none}@media(max-width:720px){.mw-parser-output .refbegin-hanging-indents>ul>li{padding-left:1.6em;text-indent:-1.6em}}.mw-parser-output .refbegin-columns{margin-top:0.3em}.mw-parser-output .refbegin-columns ul{margin-top:0}.mw-parser-output .refbegin-columns li{page-break-inside:avoid;break-inside:avoid-column}
.mw-parser-output .legend{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .legend-color{display:inline-block;min-width:1.25em;height:1.25em;line-height:1.25;margin:1px 0;text-align:center;border:1px solid black;background-color:transparent;color:black}.mw-parser-output .legend-text{}
no data
less than 40
40-120
120-200
200-280
280-360
360-440
440-520
520-600
600-680
680-760 Nephritis and nephrosis world map - DALY - WHO2004.svg
Disease burden of nephritis/nephrosis worldwide in 2004.
  no data
  less than 40
  40–120
  120–200
  200–280
  280–360
  360–440
  440–520
  520–600
  600–680
  680–760

Treatment (or management) of nephritis depends on what has provoked the inflammation of the kidney(s). In the case of lupus nephritis, hydroxychloroquine could be used. [18]

Prevalence

Nephritis represents the ninth most common cause of death among all women in the US (and the fifth leading cause among non-Hispanic black women). [19]

Worldwide, the highest rates[ clarification needed ] of nephritis are 50-55% for African or Asian descent followed by Hispanic at 43% and Caucasian at 17%. [20]

The average age of an individual diagnosed with kidney inflammation (in this case, lupus nephritis) is 28.4 years old. [21]

See also

Related Research Articles

Proteinuria Presence of an excess of serum proteins in the urine

Proteinuria is the presence of excess proteins in the urine. In healthy persons, urine contains very little protein; an excess is suggestive of illness. Excess protein in the urine often causes the urine to become foamy. Severe proteinuria can cause nephrotic syndrome in which there is worsening swelling of the body.

Nephron Microscopic structural and functional unit of the kidney.

The nephron is the minute or microscopic structural and functional unit of the kidney. It is composed of a renal corpuscle and a renal tubule. The renal corpuscle consists of a tuft of capillaries called a glomerulus and a cup-shaped structure called Bowman's capsule. The renal tubule extends from the capsule. The capsule and tubule are connected and are composed of epithelial cells with a lumen. A healthy adult has 1 to 1.5 million nephrons in each kidney. Blood is filtered as it passes through three layers: the endothelial cells of the capillary wall, its basement membrane, and between the foot processes of the podocytes of the lining of the capsule. The tubule has adjacent peritubular capillaries that run between the descending and ascending portions of the tubule. As the fluid from the capsule flows down into the tubule, it is processed by the epithelial cells lining the tubule: water is reabsorbed and substances are exchanged ; first with the interstitial fluid outside the tubules, and then into the plasma in the adjacent peritubular capillaries through the endothelial cells lining that capillary. This process regulates the volume of body fluid as well as levels of many body substances. At the end of the tubule, the remaining fluid—urine—exits: it is composed of water, metabolic waste, and toxins.

Nephrotic syndrome Collection of symptoms due to kidney damage

Nephrotic syndrome is a collection of symptoms due to kidney damage. This includes protein in the urine, low blood albumin levels, high blood lipids, and significant swelling. Other symptoms may include weight gain, feeling tired, and foamy urine. Complications may include blood clots, infections, and high blood pressure.

Hematuria Medical condition

Hematuria or haematuria is defined as the occurrence of blood or red blood cells in the urine. The word hematuria is derived from Greek haima (αἷμα) "blood" and ouron (οὖρον) "urine". Hematuria can be visible to the naked eye and may appear red or brown, or it can be microscopic. The origin of the blood that enters and mixes with the urine can arise from any anatomical site within the urinary system, including the kidney, ureter, urinary bladder, and urethra, and in men, the prostate. Common causes of hematuria include urinary tract infection (UTI), kidney stones, viral illness, trauma, bladder cancer, and exercise. The underlying causes of hematuria can be divided into glomerular and non-glomerular causes, referring to the involvement of the glomerulus of the kidney. Notably, not all red urine is hematuria. Other substances such as certain medications and foods can cause urine to appear red. Menstruation in women may also cause the appearance of hematuria and may result in a positive urine dipstick test for hematuria. Additionally, a urine dipstick test may be falsely positive for hematuria due to other substances in the urine such as myoglobin during rhabdomyolysis. A positive urine dipstick test should be confirmed with microscopy, where hematuria is defined by three of more red blood cells per high power field. When hematuria is detected, a thorough history and physical examination with appropriate further evaluation can help determine the underlying cause.

Kidney disease Damage to or disease of a kidney

Kidney disease, or renal disease, technically referred to as nephropathy, is damage to or disease of a kidney. Nephritis is an inflammatory kidney disease and has several types according to the location of the inflammation. Inflammation can be diagnosed by blood tests. Nephrosis is non-inflammatory kidney disease. Nephritis and nephrosis can give rise to nephritic syndrome and nephrotic syndrome respectively. Kidney disease usually causes a loss of kidney function to some degree and can result in kidney failure, the complete loss of kidney function. Kidney failure is known as the end-stage of kidney disease, where dialysis or a kidney transplant is the only treatment option.

Glomerulus (kidney) Functional unit of nephron

The glomerulus is a network of small blood vessels (capillaries) known as a tuft, located at the beginning of a nephron in the kidney. Each of the two kidneys contains about one million nephrons. The tuft is structurally supported by the mesangium, composed of intraglomerular mesangial cells. The blood is filtered across the capillary walls of this tuft through the glomerular filtration barrier, which yields its filtrate of water and soluble substances to a cup-like sac known as Bowman's capsule. The filtrate then enters the renal tubule of the nephron.

Acute kidney injury Medical condition

Acute kidney injury (AKI), previously called acute renal failure (ARF), is a sudden decrease in kidney function that develops within 7 days, as shown by an increase in serum creatinine or a decrease in urine output, or both.

IgA nephropathy Disease of the kidney

IgA nephropathy (IgAN), also known as Berger's disease, or synpharyngitic glomerulonephritis, is a disease of the kidney and the immune system; specifically it is a form of glomerulonephritis or an inflammation of the glomeruli of the kidney. Aggressive Berger's disease can attack other major organs, such as the liver, skin and heart.

Glomerulonephritis Term for several kidney diseases

Glomerulonephritis (GN) is a term used to refer to several kidney diseases. Many of the diseases are characterised by inflammation either of the glomeruli or of the small blood vessels in the kidneys, hence the name, but not all diseases necessarily have an inflammatory component.

Pyelonephritis Medical condition

Pyelonephritis is inflammation of the kidney, typically due to a bacterial infection. Symptoms most often include fever and flank tenderness. Other symptoms may include nausea, burning with urination, and frequent urination. Complications may include pus around the kidney, sepsis, or kidney failure.

Lupus nephritis Inflammation of the kidneys

Lupus nephritis is an inflammation of the kidneys caused by systemic lupus erythematosus (SLE), an autoimmune disease. It is a type of glomerulonephritis in which the glomeruli become inflamed. Since it is a result of SLE, this type of glomerulonephritis is said to be secondary, and has a different pattern and outcome from conditions with a primary cause originating in the kidney. The diagnosis of lupus nephritis depends on blood tests, urinalysis, X-rays, ultrasound scans of the kidneys, and a kidney biopsy. On urinalysis, a nephritic picture is found and red blood cell casts, red blood cells and proteinuria is found.

Hypertensive kidney disease Medical condition

Hypertensive kidney disease is a medical condition referring to damage to the kidney due to chronic high blood pressure. It manifests as hypertensive nephrosclerosis. It should be distinguished from renovascular hypertension, which is a form of secondary hypertension, and thus has opposite direction of causation.

Nephritic syndrome Medical condition

Nephritic syndrome is a syndrome comprising signs of nephritis, which is kidney disease involving inflammation. It often occurs in the glomerulus, where it is called glomerulonephritis. Glomerulonephritis is characterized by inflammation and thinning of the glomerular basement membrane and the occurrence of small pores in the podocytes of the glomerulus. These pores become large enough to permit both proteins and red blood cells to pass into the urine. By contrast, nephrotic syndrome is characterized by proteinuria and a constellation of other symptoms that specifically do not include hematuria. Nephritic syndrome, like nephrotic syndrome, may involve low level of albumin in the blood due to the protein albumin moving from the blood to the urine.

Urinary cast Cylindrical protein structure in urine in certain disease states

Urinary casts are microscopic cylindrical structures produced by the kidney and present in the urine in certain disease states. They form in the distal convoluted tubule and collecting ducts of nephrons, then dislodge and pass into the urine, where they can be detected by microscopy.

Interstitial nephritis Medical condition

Interstitial nephritis, also known as tubulointerstitial nephritis, is inflammation of the area of the kidney known as the renal interstitium, which consists of a collection of cells, extracellular matrix, and fluid surrounding the renal tubules. In addition to providing a scaffolding support for the tubular architecture, the interstitium has been shown to participate in the fluid and electrolyte exchange as well as endocrine functions of the kidney.

Aminoaciduria Medical condition

Aminoaciduria occurs when the urine contains abnormally high amounts of amino acids. In the healthy kidney, the glomeruli filter all amino acids out of the blood, and the renal tubules then reabsorb over 95% of the filtered amino acids back into the blood.

Rapidly progressive glomerulonephritis Medical condition

Rapidly progressive glomerulonephritis (RPGN) is a syndrome of the kidney that is characterized by a rapid loss of kidney function, with glomerular crescent formation seen in at least 50% or 75% of glomeruli seen on kidney biopsies. If left untreated, it rapidly progresses into acute kidney failure and death within months. In 50% of cases, RPGN is associated with an underlying disease such as Goodpasture syndrome, systemic lupus erythematosus or granulomatosis with polyangiitis; the remaining cases are idiopathic. Regardless of the underlying cause, RPGN involves severe injury to the kidneys' glomeruli, with many of the glomeruli containing characteristic glomerular crescents.

Glomerulonephrosis is a non-inflammatory disease of the kidney (nephrosis) presenting primarily in the glomerulus as Nephrotic Syndrome. The nephron is the functional unit of the kidney and it contains the glomerulus, which acts as a filter for blood to retain proteins and blood lipids. Damage to these filtration units results in important blood contents being released as waste in urine. This disease can be characterized by symptoms such as fatigue, swelling, and foamy urine, and can lead to chronic kidney disease and ultimately end-stage renal disease, as well as cardiovascular diseases. Glomerulonephrosis can present as either primary glomerulonephrosis or secondary glomerulonephrosis.

Diffuse proliferative glomerulonephritis (DPGN) is a type of glomerulonephritis that is the most serious form of renal lesions in SLE and is also the most common, occurring in 35% to 60% of patients. In absence of SLE, DPGN pathology looks more like Membranoproliferative glomerulonephritis

Monoclonal gammopathy of renal significance (MGRS) are a group of kidney disorders that present with kidney damage due to nephrotoxic monoclonal immunoglobulins secreted by clonal plasma cells or B cells. By definition, people with MGRS do not meet criteria for multiple myeloma or other hematologic malignancies. The term MGRS was introduced in 2012 by the International Kidney and Monoclonal Gammopathy Research Group (IKMG). MGRS is associated with monoclonal gammopathy of undetermined significance (MGUS). People with MGUS have a monoclonal gammopathy but does not meet the criteria for the clonal burden nor the presence of end organ damage seen in hematologic malignancies. In a population based study based on the NHANES III health survey; 6% of patients with MGUS were subsequently classified as having MGRS. The prevalence and incidence of MGRS in the general population or in specific populations is not known but it is more prevalent in those over the age of 50 as there is a monoclonal protein (M-protein) present in 3% of those 50 and years older and 5% of those 70 years and older, placing those 50 and older at increased risk of MGRS.

References

  1. 1 2 "Glomerulonephritis: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2015-06-14.
  2. 1 2 "Interstitial nephritis: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2015-06-14.
  3. 1 2 "American College of Rheumatology guidelines for screening, treatment, and management of lupus nephritis. | National Guideline Clearinghouse". www.guideline.gov. Archived from the original on 15 September 2016. Retrieved 23 July 2016.
  4. Keto Acids – Advances in Research and Application 2013 Edition p.220e
  5. "Acute Nephritis; Nephrosis; Nephritic syndrome information. Patient | Patient". Patient. Retrieved 23 July 2016.
  6. "Pyelonephritis: Kidney Infection". www.niddk.nih.gov. Retrieved 2015-06-14.
  7. "Lupus Nephritis". www.niddk.nih.gov. Archived from the original on 2017-01-04. Retrieved 2015-06-14.
  8. "Nephritis Symptoms". esagil.org.
  9. Shinton, N. K. (2007). Desk Reference for Hematology. CRC Press. ISBN   9781420005127 . Retrieved 2019-02-14.
  10. "Glomerular Diseases". www.niddk.nih.gov. Retrieved 2015-06-15.
  11. "Oliguria: Background, Etiology, Epidemiology". Medscape. eMedicine. Retrieved 23 July 2016.
  12. "uremia | accumulation in the blood of constituents normally eliminated in the urine that produces a severe toxic condition and usually occurs in severe kidney disease". www.merriam-webster.com. Retrieved 2015-06-14.
  13. "Hematuria (Blood in the Urine)". www.niddk.nih.gov. Retrieved 2015-06-14.
  14. Ashar, Bimal; Miller, Redonda; Sisson, Stephen; Hospital, Johns Hopkins (2012-02-20). Johns Hopkins Internal Medicine Board Review: Certification and Recertification. Elsevier Health Sciences. ISBN   978-0323087988.
  15. "Proteinuria". www.niddk.nih.gov. Retrieved 2015-06-14.
  16. Jr, Donald E. Thomas (2014-05-22). The Lupus Encyclopedia: A Comprehensive Guide for Patients and Families. JHU Press. ISBN   9781421409849.
  17. "WHO Disease and injury country estimates". World Health Organization. 2009. Retrieved Nov 11, 2009.
  18. "Hydroxychloroquine: MedlinePlus Drug Information". medlineplus.gov. Retrieved 23 July 2016.
  19. "Leading Causes of Death - Women's Health USA 2010". mchb.hrsa.gov. Retrieved 2015-06-14.
  20. Lerma, Edgar; Rosner, Mitchell (2012-10-28). Clinical Decisions in Nephrology, Hypertension and Kidney Transplantation. Springer Science & Business Media. ISBN   9781461444541.
  21. "Lupus Nephritis: Practice Essentials, Background, Pathophysiology". 2018-04-22.{{cite journal}}: Cite journal requires |journal= (help)